OBJECTIVE: To study the effects of Gegen Recipe and Guizhi Recipe regulating the expression of IL-1beta, iNOS, TNFalpha and TGFbeta mRNA in degenerated intervertebral disk caused by stimulation of wind, cold and damp. METHODS: Thirty-six rabbits were randomly separated into six groups, viz. control group, stimulation by wind, cold and damp group, head in low-location group, compound model group (head in low-location plus stimulation of wind, cold and damp), Gegen Recipe group and Guizhi Recipe group. The gene expression of IL-1beta, iNOS, TNFalpha and TGFbeta mRNA in degenerated cervical intervertebral disks were assayed by RT-PCR. RESULTS: Compared with the control group, IL-1beta mRNA and iNOS mRNA expression were up-regulated in each model group(P<0.01). Both Gegen Recipe and Guizhi Recipe down-regulated IL-1beta mRNA, iNOS mRNA expression, which had significant differences compared with the stimulation model group(P<0.01 or <0.05). TNFalpha mRNA expression was significantly enhanced in the compound model group compared with the control group (P<0.01). There was no significant difference between the head in low-location group and the stimulation model group. Gegen Recipe down-regulated TNFalpha mRNA expression compared with the stimulation group(P<0.01),while the effect of Guizhi Recipe was not significant. Compared with the control group, TGFbeta mRNA expression went down in each model group(P<0.01). Gegen Recipe up-regulated TGFbeta mRNA expression(P<0.01), while the effect of Guizhi Recipe on adjusting TGFbeta mRNA was not significant. CONCLUSION: Stimulation by wind, cold and damp, head in low-location, and compound of both can down-regulate the expressions of IL-1beta, iNOS, TNFalpha mRNA, and up-regulate the expression of TGFbeta mRNA. These researches certify that these factors take part in the progression of intervertebral disk degeneration. IL-1beta, iNOS, TNFalpha accelerate the degeneration and TGFbeta defers the degeneration. Gegen Recipe down-regulates the expression of TNFalpha mRNA and up-regulates the expression of TGFbeta mRNA. The effect on regulating the cell factors expressions by Guizhi Recipe is lower than that of Gegen Recipe.

This study was aimed to observe the natural history and evolution of cervical spondylotic myelopa-thy , explore development law of the disease incidence in order to improve the understanding of cervical spondylotic myelopathy and provide a theoretical basis for Chinese medicine treatment . Complete clinical data of 80 cervical spondylotic myelopathy cases were collected from March 1998 to July 2007 in special and ex-pert practice of Prof . Shi's out-patient department . Chinese medicine for q i-blood regulation was given in the treatment . Related measuring scales were designed . More than two-month follow-up was given through means of returning visit, telephone calls and letter inquiries. Changes of clinical symptoms, and scores of different types of evaluations were observed . The SPSS software was used in the data analysis of results from measuring scales for the objective evaluation . The results showed that there were statistical differences on the 40-score and JOA total score between initial visiting and first time follow-up ( P < 0 . 05 ) . It suggested that through Chinese medicine qi-blood regulation treatment, the scores on spinal cord function were increased compared with the previous visiting . For patients who continued long-term Chinese medicine q i-blood regulation treat-ment, there were statistical differences on the 40-score and JOA total score between the first-time follow-up and second-time follow-up ( P < 0 . 05 ) . It suggested that through continued long-term Chinese medicine q i-blood regulation treatment , the scores on spinal cord function were increased compared with the previous visit-ing . In this group of patients , there were no statistical differences on the 40-score and JOA total score be-tween the patient's initial visiting , first time follow-up , and the first-time follow-up and second-time follow-up . The scores on spinal cord function suggested that there was no obvious difference on the relieving degree between the first-time follow-up and second-time follow-up . For patients who were unable to continue the Chinese medicine qi-blood regulation treatment, no matter if it was full score on the spinal cord function in the first-time follow-up , there were statistical differences on the 40-score and JOA total score between the first-time and second-time follow-up . It suggested that the disease became worse when patients were unable to continue the Chinese medicine qi-blood regulation treatment. It was concluded that Chinese medicine qi-blood regulation treatment for cervical spondylotic myelopathy has a significant effect in both short-term and long-term treatment with steady effectiveness. Patients who continue the Chinese medicine qi-blood regulation treatment not only can prevent disease recurrence , but also can promote further relieving of disease condition .

The authors summarize Professor SHI Qi's clinical experience in diagnosing and treating chronic tendon and bone disease.The specific diagnosing and treating thinking and methods could be summarized as follows:1)Three stages,which means chronic tendon and bone disease could be treated according to early,medium and late stages.2) Three differentiations,which include differentiating disease,type and syndrome.3) Three examining,which include seeing patient clearly,reading the disease and getting the key point.In addition,Prof.SHI emphasizes threepoint syndrome differentiation which means the combination of the lesion's target,peri-target and whole syndrome characteristics differentiation.In the process of treatment,Prof.SHI emphasizes three methods combination of herb,technique and breathing technique.Both internal and external treatments should be used.Prof.SHI advocates that the control strategy should be the prevention,treatment and recuperation integration concept,including preventing disease,early treatment to prevent deterioration and preventing reoccurrence after cure.

Objective To observe the therapeutic effect of Guizhi Decoction plus Yupingfeng Powder for chronic urticaria and its effect on serum total IgE level.Methods One hundred and twenty patients were randomly divided into treatment group,control group 1 and control group 2,40 cases in each group.The treatment group was treated with Guizhi Decoction,Yupingfeng Powder and Loratadine Tablets orally,the control group 1 was given intramuscular injection of Bacillus Calmette-Guerin polysaccharide nucleic acid and oral use of Loratadine Tablets,and the control group 2 was only given oral use of Loratadine Tablets.The course of treatment covered 5 weeks.The levels of serum total IgE in the three groups were determined before and after treatment,and the therapeutic effect was evaluated after treatment.Results (1) The total effective rate was 85.0％ in the treatment group,80.0％ in the control group 1,and 55.0％ in the control group 2.The effect of control group 1 and the treatment group was superior to that of the control group 2 (P＜ 0.05),but the difference was insignificant between the treatment group and control group 1 (P＞ 0.05).(2)Before treatment,the serum total IgE level of the three groups was higher than that of the normal control group (P ＜ 0.05).After treatment,the serum total IgE level of the three groups was obviously decreased (P ＜ 0.05 compared with that before treatment);the inter-group comparison results showed that the effect of the treatment group and control group 1 on decreasing the serum total IgE level was superior to that of the control group 2(P ＜ 0.05),while the effect of the treatment group was similar to that of the control group 1 (P ＞0.05).(3) During the treatment,blood routine examination indexes and hepato-renal function of the three groups showed no abnormal changes,neither adverse reaction was shown.Conclusion Guizhi Decoction plus Yupingfeng Powder exerts certain therapeutic effect for the treatment of chronic urticaria,and can decrease the serum total IgE level,thus to stabilize the curative effect and reduce the recurrence.

Objective To report the clinical effect of repair of significant tongue defect after tongue cancer radical resection using anterolateral thigh perforator free flap with CTA three-dimensional reconstruction technique assistance.Methods From January,2012 to November,2015,13 cases were performed using anterolateral thigh perforator free flap in the repair of significant tongue defect after tongue cancer radical resection.Preoperation CT scan of the free flap donor site was done to obtain the three-dimensional images of arterial blood area by Digital Three-dimensional Reconstruction CT Technique to determine the origin of the anterolateral thigh flaps,direction,classification,length,diameter and the position of pedicle perforator.According to the condition of the defect of the tongue,flap of area from10 cm×9 cm to 8 cm×6 cm was design,the flap arteries and veins were anastomosed with the external maxillary artery or the superior thyroid artery,anterior vein,internal jugular vein or external jugular vein respectively.The shape and recovery of function of the reconstructed tongue were observed regularly after operation.Results All the flaps in the 13 cases survived,in the postoperative 4 to 18 months followed up,the appearance of the reconstructed tongue was close to the normal one,the patients were satisfied with the mastication and feeding function.Conclusion CTA three-dimensional reconstruction technique assisted anterolateral thigh perforator free flap technique is useful in obtaining good clinical effect,and it is one of the most best methods for repairing significant tongue defect after tongue cancer radical resection.

Objective:To investigate the clinical value of the free fibula flap transplantation in repair of the defect of tibia and soft tissue with the help of augmented reality (AR) technology.Methods:From May, 2017 to May, 2019, 9 patients with tibial and soft tissue defects were treated. Before operation, CTA scan was performed on both shanks to obtain DICOM data of tibial bone defect. Images of the designed fibular flap and its blood supply model were imported into Sina software through computer virtual surgery assistant technology. With the AR technology, information of virtual fibula flap were projected onto the body surface at the donor site, and the operation was carried out under the precise positioning. In this group, the free fibular flap was harvested with an area of 6.0 cm×4.0 cm-12.0 cm×6.0 cm and the length of fibula was 6.0-13.5 cm. The free fibula flap were used to repair the tibial defect with 5.0-12.0 cm in length and soft tissue defect area at 5.0 cm×3.0 cm-10.0 cm×4.5 cm. Patients were followed-up to observe the survival of fibular flap and the functional recovery of the repaired lower limb, and evaluate the clinical effect.Results:All the fibular flaps survived without vascular crisis and without serious complications occurred at both of donor and recipient sites. After 8-12 months of follow-up, the flap was soft in texture and good in blood supply. The appearance of the repair site was not bloated. Callus began to form at the junction of fibula and tibia at 3-5 months and healed well in 8-12 months. No bone resorption, nonunion, loosening or falling off of screws were found. There was no pain in the shank of the recipient area. Patients could stand and walk freely, and the weight-bearing function was close to normal. According to Enneking system, the average score was 27 points; 7 cases were excellent and 2 cases were good.Conclusion:Application of AR technology in the repair of tibial bone defect with fibular flap transplantation has good clinical effect and has certain practical value.

Free vascularised fibular flap has many advantages in repair of mandibular defects, and it has become the main method in the mandibular reconstruction. However, the traditional free fibular flap used to repair the mandibular defect is lack of individualised design and precise surgical guidance, and it is difficult to achieve accurate repair and the effect of reconstruction. The concept of personalised and accurate functional reconstruction and the clinically application of digital medical technology provides a new approach to solve the problems. The application of digital medical technology in the repair of mandibular defects with fibular flap is one of the hotspots of current research. This article introduces the application characteristics of digital medical technology, such as 3-dimensional reconstruction technology, virtual surgery planning (VSP) technology and 3D printing technology, in the repair of mandibular defects with fibular flap transfer.

Objective :To explore influence of intra—arterial thrombolysis combined hyperbaric oxygen on serum levels of soluble intercellular adhesion molecule—1 (sICAM—1) and calcitonin gene related peptide (CGRP) in patients with severe ischemic stroke .Methods : A total of 96 patients with severe ischemic stroke in our hospital were randomly and equally divided into thrombolysis group and combined treatment group (received intra—arterial thrombolysis +hyperbaric oxygen therapy ).United States National Institutes of Health Stroke score (NIHSS) was used to assess neurological function recovery , and modified Rankin rating score (mRS) was used to assess recovery of clinical symptoms.After two—week treatment ,clinical therapeutic effect etc .were compared between two groups .Results :Compared with thrombolysis group after treatment ,there was significant rise in total effective rate (77.08% vs. 93. 75%, P＝0.021) ;significant reductions in scores of NIHSS [ (8.10 ± 3.45) scores vs .(5.36 ± 2.11) scores] and mRS [ (2.58 ± 0. 80) scores vs .(1.81 ± 0.76) scores] ;significant reduction in serum sICAM—1 level [ (237.31 ± 18. 04) ng／ml vs.(220.25 ± 16.40) ng／ml] ,and significant rise in serum CGRP level [ (27.02 ± 6.06) pg／ml vs. (35.24 ± 6.13) pg／ml] in combined treatment group , P＝0.001 all.There was no significant difference in revascu—larization within two weeks between two groups , P＝0.551. Conclusion : Intra—arterial thrombolysis combined hy—perbaric oxygen possesses significant therapeutic effect on patients with severe ischemic stroke .It can relieve clinical symptoms ,recover cognitive function ,improve revascularization rate in these patients .

Objective To evaluate the value of 3D printing technology to assist in the repair of severe damage to the radial side hand.Methods From March,2014 to September,2016,there were 9 cases suffered from varying degrees of metacarpal and phalangeal bones injuries with soft tissue destruction at the radial side of the hand.The donor and recipient areas were scanned by 64 row spiral CT before operation.Three dimensional images were obtained by CTA 3D reconstruction technology.Preoperative plan was designed by using Mirror image technology and Virtual surgery aided design technique of Mimics software virtual surgery aided design system.Nine cases were treated with first toe toenail flap with dorsal foot flap combined with second phalangeal bone transplantation to reconstruct thumb and anterolateral thigh perforator flap to repair the wound.The cutting area of the dorsalis pedis flap and anterolateral thigh perforator flaps ranged from 4.0 cm × 5.5 cm to 6.5 cm × 9.5 cm and from 9.5 cm ×17.0 cm to 12.0 cm × 25.5 cm,respectively.Postoperative followed-up was performed to evaluate the effect of the operation.Results All 9 thumbs and flaps survived after the operation.Postoperative followed-up time ranged from 8 to 16 months.The appearance of reconstructed thumb was close to normal,and the two-point discrimination was from 8.0 to 11.0 mm.According to the evaluation criteria of upper limb function of the Chinese Academy of Medical Sciences,7 cases were excellent and 2 cases were good.The survival flaps had soft texture,good blood circulation and satisfactory appearance at the repaired site.Conclusion 3D printing technology assists thumb reconstruction and wound repair for severe damage to the radial side of the hand with good clinical results.

Objective:To discusses effectiveness of CTA in the classification of first plantar metatarsal artery and its application value in thumb reconstruction.Methods:Thirty-six cases who underwent thumb reconstruction with free second toe or hallucis flap between December, 2015 and December, 2018 were retrospectively analyzed. Among these cases, 22 cases were injured by machine stranding, 7 cases by heavy objects, and 7 cases were injured by rolling. Exact first plantar metatarsal arteries of all these cases were evaluated by using CTA preoperatively. And compared with intraoperative findings at the donor sites. Free first or second toe flap for thumb reconstruction were designed preoperatively based on branching pattern of first plantar metatarsal arteries.Results:The origin, course, 3-dimensional (3D) anatomical relationship with surrounding tissues and branching pattern of all these feet first plantar metatarsal arteries of 35 cases (70 feet)were well displayed in CTA images, and 1 case (2 feet) were showed poor vascular continuity and artifacts in CTA (2.78%). According to the branching pattern of first plantar metatarsal arteries, 29 cases (58 feet, 80.56%) were ramifying type, 5 cases (10 feet, 13.88%) were main trunk type, and 1 case (2 feet, 2.78%) were tiny branch type. Preoperative CTA images and intraoperative findings at the donor site of 35 cases were remarkably consistent. According to CTA images, 27 cases underwent thumb reconstruction with hallucis flap, 8 cases underwent thumb reconstruction with second toe, and 1 case of poor vascular continuity and artifacts in CTA underwent thumb reconstruction with hallucis flap eventually. All these cases were followed-up for 6-24 (average 12) months, and all reconstructed thumbs survived. The clinical outcomes of all these reconstructed thumbs were good with satisfactory appearance, sensory recovery, excellent motion. The donor feet of all cases recovered well.Conclusion:High-quality 3D images of first plantar metatarsal arteries could be obtained by CTA, allowing preoperative assessment of blood supply and planning of donor site. Therefore, success rate of reconstructed operation could be improved with low disability rate of donor site.